Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1845-1856
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1845
Compare clinical efficacy and safety of neoadjuvant therapy and neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Meta-analysis
Ying Wang, Yan Yang, Qi-Qi Liu, Shao-Zhao Wang
Ying Wang, Department of Anus Intestinal Surgery, Feicheng People’s Hospital, Feicheng 271600, Shandong Province, China
Yan Yang, Department of Gastroenterology, Qingdao Hospital of University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao 266011, Shandong Province, China
Qi-Qi Liu, Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
Shao-Zhao Wang, Department of Anorectal Words, Central Hospital Affiliated Shandong First Medical University, Jinan 250013, Shandong Province, China
Author contributions: Wang Y wrote the manuscript; Yang Y and Liu QQ collected the data; Wang SZ guided the study; and all authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shao-Zhao Wang, MM, Doctor, Department of Anorectal Words, Central Hospital Affiliated Shandong First Medical University, No. 105 Jiefang Road, Jinan 250013, Shandong Province, China. wangsztcm@163.com
Received: January 19, 2024
Revised: April 1, 2024
Accepted: April 28, 2024
Published online: June 27, 2024
Processing time: 162 Days and 23 Hours
Abstract
BACKGROUND

To compare the efficacy and safety of total neoadjuvant therapy (TNT) and neoadjuvant chemoradiotherapy (nCRT) in the treatment of middle and low locally advanced rectal cancer. Our study will systematically collect and integrate studies to evaluate the ability of these two treatments to improve tumor shrinkage rates, surgical resection rates, tumor-free survival, and severe adverse events.

AIM

To provide clinicians and patients with more reliable treatment options to optimize treatment outcomes and quality of life for patients with locally advanced rectal cancer by comparing the advantages and disadvantages of the two treatment options.

METHODS

A full search of all clinical studies on the effectiveness and safety of TNT and nCRT for treating locally advanced rectal cancer identified in Chinese (CNKI, Wanfang, China Biomedical Literature Database) and English (PubMed, Embase) databases was performed. Two system assessors independently screened the studies according to the inclusion and exclusion criteria. Quality evaluation and data extraction were performed for the included literature. We used RevMan 5.3 software to perform a meta-analysis of the pathologic complete response (pCR) rate, T stage degradation rate, resection 0 (R0) rate, anal grade 3/4 acute toxicity rate, perioperative complications, overall survival (OS), and disease-free survival (DFS) in the TNT and nCRT groups.

RESULTS

Finally, 14 studies were included, six of which were randomized controlled studies. A total of 3797 patients were included, including 1865 in the TNT group and 1932 in the nCRT group. The two sets of baseline data were comparable. The results of the meta-analysis showed that the pCR rate [odds ratio (OR) = 1.57, 95% confidence interval (CI): 1.30-1.90, P < 0.00001], T stage degradation rate (OR = 2.16, 95%CI: 1.63-2.57, P < 0.00001), and R0 resection rate (OR = 1.42, 95%CI: 1.09-1.85, P = 0.009) were significantly greater in the nCRT group than in the nCRT group. There was no significant difference in the incidence of grade 3/4 acute toxicity or perioperative complications between the two groups. The 5-year OS [hazard ratio (HR) = 0.84, 95%CI: 0.69-1.02, P = 0.08] and DFS (HR = 0.94, 95%CI: 0.03-1.39, P = 0.74) of the TNT group were similar to those of the nCRT group.

CONCLUSION

TNT has greater clinical efficacy and safety than nCRT in the treatment of locally advanced rectal cancer.

Keywords: Neoadjuvant therapy; Neoadjuvant chemoradiotherapy; Advanced rectal cancer; Clinical efficacy; Meta-analysis

Core Tip: The main aim of this study was to perform a meta-analysis and compare the clinical efficacy and safety of neoadjuvant therapy and neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. We will collect and synthesize relevant research data to evaluate the performance of the two treatments in terms of the tumor shrinkage rate, surgical resection rate, tumor-free survival rate and other clinical indicators and analyze the safety differences between the two treatments in terms of the incidence of serious adverse events and other aspects. Through in-depth exploration of the advantages and disadvantages of the two treatment schemes, the aim is to provide more guiding treatment suggestions for clinicians to optimize the choice of treatment schemes for patients and improve the treatment effect and quality of life.